Pregnancy Interruptions in Eastern Cameroon

A review of Ambiguous Ambitions: On Pathways, Projects, and Pregnancy Interruptions in Cameroon, by Erica van der Sijpt.

Erica van der Sijpt’s dissertation presents an innovative, contemporary ethnographic investigation of the highly uneven landscape of reproductive aspirations and challenges among Gbigbil women in Eastern Cameroon. In particular, van der Sijpt sets out to unravel how Gbigbil women navigate “pregnancy interruptions” — that is, reproductive terminations ranging anywhere from a miscarriage, a stillbirth, an abortion, or the death of an infant child — and what their experiences can tell us about the larger social, economic, and religious forces that shape their lives. Here, van der Sijpt seeks to question and move beyond existing dichotomies in the literature on childbirth between spontaneous versus induced abortions, notions of suffering versus agency that accompany these two categories (respectively), and a time-based division between miscarriages and stillbirths. What emerges is a superbly subtle and dynamic picture of how Cameroonian women juggle the competing demands of social respectability, kin obligations, economic stability, and personal health in their quest to create viable lives for themselves and their offspring.

Drawing on the concept of “vital conjunctures” (Jennifer Johnson-Hanks, Uncertain Honor: Modern Motherhood in an African Crisis. Chicago: University of Chicago Press, 2006), meaning the possibilities opened up by crucial times of transformation in one’s life, the author seeks to understand how women make decisions during these periods of uncertainty. Here, the author is particularly interested in the ways in which these decisions are informed by social connections, the women’s envisioned life projects, and the physicality of their bodies. The first two chapters, which make up Part 1 of the dissertation, lay the groundwork for such an endeavor by situating the institution of childbirth in a wider social context and by delineating — in fascinatingly rich ethnographic detail — the local valences of categories such as marriage, the beginning of life, and embryology. In Chapter 2, for instance, we learn that “it is not the time but the amount of force which determines the maturity or prematurity of babies” (pp. 73-74), which diverges from time-based biomedical frameworks of fetal development. One of the insights gained in this discussion is that pregnancy comes to be seen as a fundamentally social affair, as the fetus is not only “believed to be made up of the essential physical substances (blood and force) of social others,” but as its development is subject, more broadly, “to social definitions and negotiations” (p. 202).

The second part of the dissertation comprises three chapters, each of which is dedicated to a particular end. Chapter 3 tackles the biomedical distinction between miscarriages, stillbirths, and neonatal or infant deaths by delineating how these time-based biomedical categories are less meaningful in local thought, as women differently appropriate the meanings of pregnancy loss according to their own ambitions. Chapter 4 is concerned with blurring the line between spontaneous versus induced abortions. As it turns out, “spontaneous interruptions are often suspected to be provoked; induced abortions are often presented as spontaneous” (p. 156). In Chapter 5, this thread is continued with a particular eye to the forms of agency that accompany pregnancy interruptions. The author presents a striking analysis of how women purposefully avail themselves of “idioms of suffering, fate, resignation to religious dogma, or submission to patriarchy” to “exert their ‘politiques’” and strategically maneuver times of change and distress (p. 198). Each of these chapters is introduced by one or more vignettes of individual cases of Gbigbil women whose particular trajectories exemplify the complicated and often tortuous paths taken by those who must plot a course through the thicket of reproductive terrains.

Notably, Erica van der Sijpt takes up Cecilia Van Hollen’s call to view reproduction as a “key site for understanding the ways in which people reconceptualize and reorganize the world in which they live,” rather than as a mere reflection of existing socio-cultural systems (Cecilia Van Hollen, Birth on the Threshold: Childbirth and Modernity in South India. Berkeley: University of California Press, 2003, p. 5). What is striking about the multiple pathways the author charts for the women who take center stage in her ethnography is that these pathways are extremely heterogeneous, at times controversial, and always in reference to wider socio-economic and personal projects. Chapter 4 discusses the case of several Gbigbil women who deliberate to whom to “give” their pregnancy, in an effort to bargain for the most promising future for themselves and their child. In Chapter 5, too, we are introduced to the colorful figure of Mama Rosie, who tactically manages the implications of her infertility later in life. The author uses her case to demonstrate that rural Cameroonian women cannot be portrayed as passive victims who “suffer under patriarchal and pronatalist demands” (p. 181). In this (much appreciated) move against prevailing development discourses of “empowering” women of the Global South by “saving” them from their own husbands, the author questions assumptions that would always and already associate women with speechlessness and men with forms of oppression. At the same time, the author is careful not to interpret abortions as the “ultimate form of agency,” as done by many contemporary feminists (p. 180).

In conversation with leading African anthropologists, such as Peter Geschiere, Jane Guyer, or Charles Piot, the author, importantly, links herself into contemporary Africanist debates on the informal economy, witchcraft accusations, the growing economic insecurity among urban and rural youth, as well as medical pluralism (in a context where biomedicine and its local counterparts often work in cooperation, rather than in competition, with one another). This research has a substantial impact not only on the growing literature on childbirth, gender, and medicine in anthropology, but also on the increasingly pertinent field of global public health. Besides academics, public policy makers will find much food for thought in this multifaceted portrayal of the particular kinds of moral and economic struggles and constraints that surround modern-day reproduction in Cameroon and beyond.